1751. Carbapenem-Resistant Klebsiella pneumoniae Problem in Pediatric and Neonatal Intensive Care Units: from Colonization to Infection
Session: Poster Abstract Session: Pediatric Bacterial Infections
Saturday, October 10, 2015
Room: Poster Hall
Posters
  • IDSA-POSTER (1).pdf (287.8 kB)
  • Background: Risk factors for acquisition of carbapenem-resistant Klebsiella pneumoniae (CRKP) colonization is well studied in studies mainly involving adult population. However, evaluation of frequency and risk factors of CRKP infection occurrence in patients rectally colonized with CRKP is a rarely studied issue, especially in pediatric population.  

    Methods: A retrospective observational cohort study was conducted involving pediatric and neonatal intensive care units (PICU and NICU) throughout 5 year period (January 2010 - December 2014). Medical, microbiological and laboratory data were extracted from Hospital Infection Control Committee reports and patients’ medical reports. CRKP colonized (CRKP-C) patients who did not develop infection were compared to those who did develop subsequent infection with CRKP (CRKP-I),  regarding possible risk factors.

    Results: Throughout the study period, 1.3% of patients admitted to NICU and 3.6% of patients admitted to PICU had become colonized with CRKP. In PICU, 39.0% of the colonized patients developed infection, while in NICU 18.1%. Types of infection associated with CRKP were determined as primary bacteremia (62.5%), ventilator-associated pneumonia (16.6%), ventriculitis (8.3%), intraabdominal infections  (8.3%), urinary tract infection (4.1%). A logistic regression model including parameters found significant in univariate analysis of CRKP-C and CRKP-I groups revealed underlying metabolic disease (OR:10.1; CI:2.7-37.2), previous carbapenem use (OR:10.1; CI: 2.2-40.1), neutropenia (OR:13.8; CI: 3.1-61.0) and previous surgical procedure (OR:7.4; CI: 1.9-28.5) as independent risk factors for occurrence of CRKP infection in patients colonized with CRKP. Out of 24 patients with CRKP-I, 4 (16.6%) died of CRKP sepsis. 

    Conclusion: Asymptomatic colonization with CRKP in intensive care units of pediatric departments should alarm health care providers about forthcoming CRKP infection. Those CRKP colonized patients at risk of developing infection due to CRKP may be targeted for interventions to reduce subsequent infection occurence and also for timely initiation of empirical CRKP active treatment, when necessary.

    Hacer Akturk, MD1, Ayper Somer, Prof1, Nuran Salman, Prof1, Murat Sutcu, MD1, Rukiye Cihan, Nurse2, Asli Ozdemir, Nurse2, Asuman Coban, Prof3, Zeynep Ince, Prof3, Agop Citak, Prof4 and Derya Aydin, Prof5, (1)Pediatric Infectious Diseases, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey, (2)Hospital Infection Control Committee, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey, (3)Neonatology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey, (4)Pediatric Intensive Care, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey, (5)Clinical Microbiology, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey

    Disclosures:

    H. Akturk, None

    A. Somer, None

    N. Salman, None

    M. Sutcu, None

    R. Cihan, None

    A. Ozdemir, None

    A. Coban, None

    Z. Ince, None

    A. Citak, None

    D. Aydin, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.